Packets of chewing tobacco sold across India after December 1, 2011 will have to show graphic images portraying the disfiguring effects of oral cancer, but cigarette and bidi packets may show milder pictures, the Union health ministry said today.

The health ministry has notified two new sets of pictorial warnings — harsher images for packets of chewing tobacco — that will replace the existing pictures, scorpions on chewed tobacco products, and diseased lungs on cigarette and bidi packets.

Cancer and public health specialists have welcomed the new images, but pointed out that the choice of images given to manufacturers of smoking tobacco will allow them to use a milder warning of a man with diseased lungs rather than of mouth cancer.

“I’m not happy at all at the choice of pictures for smoking tobacco products,” said Pankaj Chaturvedi, an associate professor of head and neck cancer surgery at the Tata Memorial Hospital, Mumbai.

“Pictorial warnings need to have a strong deterrence effect that impacts people — the pictures for chewing tobacco are likely to have such an effect, but the pictures for smoking tobacco don’t,” he said.

“The new four pictures for chewing tobacco are very similar and graphically depict the consequences of mouth cancer,” said Monika Arora, the head of health promotion and tobacco control at the Public Health Foundation of India, New Delhi.

But three of the four images for smoking tobacco packets show a male with lungs in different stages of disease, while the fourth image shows a gross lesion on the mouth caused by oral cancer.

“Manufacturers are more likely to pick one of the pictures showing the man with diseased lungs rather than the picture of oral cancer,” a source in the health ministry said.

The new health warnings, due since June 2010, are expected to be implemented by all manufacturers from December 1, 2011. Anti-tobacco activists believe that lobbying by sections of the tobacco industry has contributed to the delay in the new warnings.

The new pictures will be used for two years after which the health ministry is expected to issue a fresh set of pictures.

Health ministry sources said harsher pictures have been selected for chewed tobacco because surveys have shown that more men and women in India use smokeless tobacco, mainly chewing tobacco, than smoking tobacco.